APPLICATION FOR

SEPARATE CLASSROOM INCLUSION

The application approval process may take up to six weeks.

To complete this document, place your cursor in each box or on each line and key the information. Answer spaces will expand to accommodate all your information.

Institution
ABHES ID#
Street Mailing Address
City / State / Zip Code
Telephone / Fax
Website Address
Chief Executive Officerof Institution:
On-site Director/Administrator:
E-mail Address (on-site administrator to receive ABHES visit correspondence):

Separate Classroom:

Street Mailing Address
City / State / Zip Code
Please explain the justification for opening a separate classroom:
Distance from Main/Non-main Campus:
blocks / ½-1 mile / miles

If the distance from the main/non-main campus is more than one mile, explain how the location of the separate classroom is “within customary and reasonable commuting distance of the main or non-main campus.” (Chapter II, Section B, Subsection 3d. of the Accreditation Manual):

Proposed date to open the separate classroom:
(Month/Day/Year)
Proposed number of students who will have classes taught in the separate classroom:
Name and title of person responsible for supervision and administration of the separate classroom:
Name / Title
Will this person be located at the / main/non-main campus or / separate classroom?

List the names of faculty who will be located at the separate classroom, the program in which they instruct, and the number of hours per week they will be located at the separate classroom:

Instructor / Program / Courses Taught / Hours/Week

Identify the courses, including clock hours, to be offered at the separate classroom:

Course ID # / Title / Clock Hours / Quarter/Semester Credit

If all the courses listed above are part of one program offering, identify below the program name and list the courses within the program that will still be offered at the main or non-main campus:

Program Name:
Course ID # / Main / Non-Main / Title / Clock Hours / Quarter/Semester Credit

Attachments:

Please attach the following information to this application:

1. A current catalog including information relative to the separate classroom.

2. State approval for the separate classroom.

3. A curriculum vitae for all instructors teaching at the separate classroom.

4. A brief description and a floor plan for the separate classroom.

5. An equipment list for the separate classroom.

6. The application fee (See the fees appendix in the Accreditation Manual. Application fee is not refundable.)

Signature of Chief Executive Officer / Date:

Separate Classroom Application 3

10/3/13

APPLICATION SUBMISSION

Submit the completed application* on a USB drive or on a compact disk CD and the application fee (See the fees appendix in the Accreditation Manual. Application fee is not refundable.) to:

ABHES

7777 Leesburg Pike, Suite314 North

Falls Church, VA 22043

*The application must be submitted as one* seamless Portable Document Format (.pdf) file. The application may not be submitted to the Commission via e-mail. It is imperative that the USB or CD is correctly labeled with the (1) institution’s name, (2) city/state, (3) ABHES ID #, (4) “Separate Classroom Application.”

If you have any questions regarding the application, please call us at 703-917-9503.

Separate Classroom Application 3

10/3/13